Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Chapter 25 Putting It All Together for the Medical Patient

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Overview

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Putting It All Together Management of patients with more than one medical complaint Management of patient conditions not covered in the EMT course

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Multiple Medical Complaints Injuries versus illnesses Injuries—more specific Illnesses—confusing picture

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Basics of Management All patients receive an initial assessment and care for life- threatening injuries. Do not be distracted by gruesome injuries or the serious nature of the call.

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Decisions Priority decision Circulation Breathing Airway

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Interventions Inhaler, nitroglycerin, EpiPen ® Oral glucose or activated charcoal Cooling or warming Restraining Childbirth

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Cultural Considerations Germ theory of disease causation Native Americans

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Case #1 Overdose of Pills

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Case #1—Overdose Female has taken pills. Scene—safe Initial impression—sleepy Airway Breathing Circulation

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Assessment Findings Vital signs –Pulse: 96 and full –BP: 100/70 –Respirations: 14 and adequate –Skin: warm and dry

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Decision Stay and play, or load and go? How long ago did the incident occur? What type of pills were ingested? Last meal? Past medical history? Allergies? Do we give oral glucose or not? Charcoal? Consult medical direction.

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Medical Direction Patient condition History What medications involved? Assessment findings

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Patient Response Refuses activated charcoal Transport - uneventful

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Thoughts Condition technically fulfilled the criteria for administration of oral glucose Did the protocol ever picture a situation where the patient had also taken an overdose?

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Physician Feedback Glad you consulted with him on the radio Patient is being admitted. Reaffirms his appreciation

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Case #2 Chest Pain

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Case #2—Chest Pain Older man with chest pain Scene—safe Initial impression—anxious and uncomfortable Airway Breathing Circulation

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Assessment Findings Vital signs—pulse 84, BP 118/90, respirations 22 Skin—pale and sweaty Breath sounds—equal on both sides Oxygen saturation—98% on room air

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Background Information On-line medical direction prior to nitroglycerin Nitroglycerin only if systolic BP >100mmHg

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Decision Stay and play, or load and go? SAMPLE OPQRST Give nitro and recheck BP

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Case Progression Assist patient with nitroglycerin. Transport. Re-evaluation: –Vomits what looks like coffee grounds and bright red blood –15 minutes from hospital –Relief from nitroglycerin and oxygen –Vitals: BP 102/80, HR 92 and weak, R 22, skin—pale and sweaty

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Physician Feedback Vomiting blood—what does that mean? Ibuprofen use—side effects Angina Good job Lab results

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Case #3 Allergic Reaction

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Case #3—Allergic Reaction Female patient stung by a bee Scene—safe Initial impression—mid 20s, anxious, hives on neck and arms Airway Breathing Circulation

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Assessment Findings Vital signs—BP 110/80, HR 88, R 20 Skin—warm and dry, with itching on neck and arms Breath sounds—equal on both sides; no wheezes Oxygen saturation—98% on room air

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Decision Stay & play or load & go SAMPLEOPQRST Use the epinephrine

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Background Information Protocol requires contact with medical direction. Epinephrine available.

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Case Progression Re-evaluation –Wheezes heard without stethoscope. –Difficulty breathing increased. –Hives increased. –Vitals: BP 102/80, HR 104, R 24 and labored, skin—pale and sweaty

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Physician Feedback Why hold off the epinephrine initially? Effects of epinephrine

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Analysis of Calls Judgment Straightforward vs. vague complaints Life threats Resources available

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Multiple Medical Complaints

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ EMT Consistency Shock treatment (hypoperfusion) Airway management Assess patient and provide appropriate supportive care

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Examples Abdominal pain –Treat for shock if present. Compromised airway –Clear the patient’s airway. No specific interventions –Post-surgical complications –Headache –Sickle cell

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Principles Assess the patient Identify and treat problems that you can treat Follow protocols for calling for assistance Provide basic EMT-level care

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Managing Unusual Situations Unknown disease Unfamiliar medical equipment

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Review Questions 1. What are the decisions an EMT must make for a medical patient with regard to interventions? 2. What steps should the EMT follow when a patient seems to require two interventions? 3. What are the advantages to consulting on-line medical direction in a difficult medical case? (cont.)

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Review Questions 4. How can an EMT learn more about a patient’s complaint that is not covered in the EMT curriculum? 5. What is an appropriate response on the part of an EMT when a patient tells him she has Crohn’s disease?

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Street Scenes What pertinent signs or symptoms should you inquire about? What further patient assessment should you perform? (cont.)

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Street Scenes What treatment should you provide to Mr. Jones at this time?

Limmer et al., Emergency Care, 11th Edition © 2009 by Pearson Education, Inc., Upper Saddle River, NJ Sample Documentation